Insulin emergency question

I was away from my house and when I was at an event I looked for my insulin in my bag but I forgot it. I was about 1 hour 20 mins away from my house and I had high sugar at 300. I went to a CVS and the pharmacy was open but they wouldn't give me any insulin, even though I told them I felt really sick and my blood sugar was 300. Then I called an ambulance because I was feeling so bad, they told me they didn't have any insulin in the ambulance so they couldn't do anything for me. I had to go to the closest emergency room and they made me fill out a lot of paper work and kept asking me a lot of questions that took forever even though I told them I need insulin fast because I am feeling really sick and bad. When I finally talked to the doctor he said they didn't have any insulin only humulin! In an emergency can CVS or another drug store give you the insulin you need from the pharmacy without a prescription? It seems like someone could die if they wouldn't give them insulin in an emergency, I sure felt like I was about to pass out and my head and jaw was so tight I could barely open my mouth. I was so mad and frustrated, mostly really mad at myself and it ruined my family's night. I sometimes wonder whats wrong with me.

I'm not sure of what the policies are in the US, but I know in Canada at least that Insulin in general can be purchased without a prescription. A prescription is only required if you are wanting to bill it to a health plan.

The ambulance should have taken you to the hospital if you weren't feeling well, especially since you are a diabetic and you had already called them. It also seems strange that the emergency room wasn't able to work with you to bring down your blood sugars, and if they weren't able to provide you with insulin they should have administered it for you.

At the very least, they would have been able to write you a prescription to go to the nearest pharmacy and get some.

Sorry to hear that you had a rough experience, and hope things look up for you. Don't blame yourself as it happens to the best of us. You shouldn't blame yourself, or think that you ruined anyones night - people forget things, and you can't help that you're a diabetic any more than I can. It happens, they'll get over it, and the important thing is that you're okay now.

Generally speaking unless you are getting R or NPH..a pharmacy cannot dispence Insulin without a prescription. It seems like that is a general rule of thumb about R and NPH..but that may vary from state to state.

The ambulance SHOULD have transported you to the ER. No they are not going to administer insulin themselves...esp without an order from the MD.

The ER should have at least treated you in the hospital to bring your BS back down, and if NEED be write you a prescription. Heck even an IV with a little Regular insulin as an insulin drip would have been a better option than what it sounds like you got.

I wouldn't say anything's wrong with you. I haven't done it for a while but have very occasionally forgotten meds to go out to eat or once on a vacation (it made it much easier to have used Walgreens...) and have to turn around and go home or go get some. When my pump blew up it was July 2 last summer, Saturday so I could either take Humalog every hour or two or go get some NPH and I just did that.

I used IV R for years as "Fauxalog" although it is quite crazy, dropping BG from 350 to the 70s in like 1/2 hour...

I should have been more specific. Regular and NPH Insulin can be purchased without a prescription in Canada. I don't believe that the others like Lantus are available without one.

EMT's administer medication all the time without a Doctor's order. Something else had to be in play besides
not having a Doctors order.

Seems odd this ER did not have insulin analogues. Should you run into this problem again Humilin R can be taken in similar doses as you would take your Humalog/Novolog but it takes a good deal longer to start working and works over a longer period of time.

Nothing is wrong with you. Don't beat yourself up! It happens. Sorry for the horrible ordeal.

I can't believe the ER didn't have the insulin you needed. That's shocking because hospitals always have rapid acting insulin. Was it a hospital, or one of those emergency clinics? Also shocking the ambulance wouldn't transport you.

As the others said, pharmacies can't dispense Rx meds without a prescription. Against the law. I moved my prescriptions from a locally owned pharmacy to CVS so my meds are on their computer system in case I'm out of town & need something.

i think i would have sought out a medcheck or something similar and asked fro a one or two bottle insulin script. When folks need insulin this happens to me sometimes, I call my regular doctor if they are located in the same state and ask them to call in a script to a local pharmacy. Now if that don't work out, I would find an open med check deal and i would get my doctors service on the telephone with the doctor at the med check. Let them know that I have a doc and giving me a script is somewhat routine. If the docs are in different states, at least they all have similar training. (Maybe) LOL

rick phillips

It depends...on what level of training they have...are they EMT's or Paramedic's...even then generally they DO require a Dr's order to administer medications. Short of someone being in cardiac arrest.I am sure they do have standing orders for administration of some medications, but I am sure with insulin it WILL require a DR who is generally being consulted while enroute WHAT to administer. There could be a million reasons WHY someone is having the symptoms they do, and unfortunately short of you being unconscious or thisclosetodead they are NOT going to give you a shot of insulin and send u on your way. It is way to much of a liability for someone who is NOT of the level of a MD to just shoot someone up with Insulin without a Dr ordering it and how much to give. Yes we maybe able to tell them hey this is what I take and how much...but there is a liability factor as well, and if something were to go horribly wrong...guess who is the one being blamed...the under qualified medical worker. I am NOT knocking EMT's or Paramedics, but only there is a "chain of command" and even someone who is in cardiac arrest they are to be consulting the Dr via radio for orders of what to administer and how much to administer. After re-reading the OP's comment she said the ambulance did NOT carry insulin in the ambulance, which THAT makes sense. At that point she could do one of two thing...have the EMT's transport her to the ER which probably would have gotten her seen sooner...OR go to the ER herself and wait to be triaged. AND denpending on who is coming in via ambulance...or who else arrives with even more serious symptoms...they go first. I am NOT knocing the seriousness of High blood sugar, but as long as her vital signs are stable yes she may feel like crap...but its going to be a priority thing to the ER and ER's are always backed up. I mean I was seen not to long ago to rule out a potential DVT. I waited HOURS. Unfortunately that is what u get when people use the ER's as a means of being their PCP...and go for runny noses, rashes and sore throats. It causes a massive back up and people who are more seriously ill while not critical then have to wait for treatment areas to be free, and the Dr to be free of all the runny noses, ear aches and sore throats.

My concern would be more why the ambulance did not transport. Did the Op just call the ambulance service and ask if they could give her a shot...or did they acctually come out to where she was and evaluate her. Either way not knowing the situation, but people can refuse transport to the nearest ER. I find it very strange that had the ambulance been called out...and as long as the OP did not deny a transport to the ER,, that they would not have taken her and if so I would find that more problematic than the EMT's not giving her a shot of insulin and that being that. I work in the medical field and I see ER reports all the time of people arriving in ER via ambulance for "stomach aches" and "head aches". If the OP felt she truly needed medical assistance...the ambulance service if called out SHOULD have transported her to the nearest ER.

In almost all of the US, regular and NPH insulin are over-the-counter, no prescription required. But maybe not everywhere. And many states and localities have asinine laws about syringes.

How old are you? When I was in my late teens/early 20's, college years, pharmacists were real good at making up reasons for why I couldn't buy insulin or syringes. Even after I got them to look me up in the computer, and that I'd had a prescription for insulin and syringes at that chain of pharmacy for most of a decade, they would make up reasons. I think they just didn't want to get in trouble for selling something to a kid.

Oh grrrrr my post is so rambled...but just for future for Tony if something like this were to happen again. No you are not going to get insulin just by calling the ambulance, they really MOST likely would NOT carry it on an ambulance, and at that point I would have told them I felt to sick to go get myself to the nearest ER can I please have an ambulance come out and transport me.

I agree I think the call was handled poorly a decent ambulance service would have told you if this was a medical emergency to call 911 and request an ambulance transport you to the ER. That is the fastest way to be seen in an ER, otherwise if you just walk in you are put in triage and will wait forever.

I understand your fustration, especially when we know what is wrong, but you also have to look at it from a medical person's standpoint. Especially in the ER, they know NOTHING about you when you walk into that door. It's not to inconvience you or treat you poorly. But there is protocol to follow, and a huge liability for Medical workers if they skip that protocol and something goes wrong. I would definately advise as was suggested. Transfer your prescriptions to chain like Wal-greens or CVS somewhere where your prescriptions are on their computer system regardless of where you are.

hum, this seems odd...emergency rooms administer insulin of all kinds every day, that's where people who are DKA go, typically when in the ER, you don't really fill out any just go and give them your name, insurance and wait for triage. every hospital has insulin of all kinds.

Im wondering if it were truly an "emergency room" or one of those doc in a box places. LOL you know 24 hour free standing urgent care facilities. In those types of places I could imagine their supplies of insulin "might" be limited. But definately not in an ER in a hospital. Even if they didnt have that particular insulin in their medication drawers in the ER, they can request it from pharmacy, or even another department. When I worked in the hospital on a progressive care unit, I didnt have a medication that I needed, but the ICU deparment did. I was able to go up to ICU and they pulled the medication I needed from their department.

And even walking into an ER department to be seen I have never had to fill out much paperwork, like you said its mostly showing them your insurance card, drivers lic, and signing a form to consent for treatment...and then the LONG wait to be seen.

i would imagine even they would have insulin...and/or transport someone to ER to get insulin...something about this doesn't seem right, just sayin'?

Well doc in the box even if they only had like R insulin...they could have written a prescription for what you needed. I think to not knowing where exactly this happened at, the size of the town/city. My only thought about like free standing urgent care centers not having stuff like humalog, or novalog, apidra they are expensive insulins, that generally once opened have an expiration date of about a month. Cost wise for a free standing urgent care facility, it might be cheaper to just have R insulin in stock. R is what is used when you do an Insulin drip. For a free standing facility it would serve their purposes in a cost efficient manner. I just dont get why if they couldnt administer humalog or something like that, then as long as she wasn't "critical" They should have administered the R an IV monitored her to make sure her BS was coming down, and write her a script for what she uses, esp if she wasnt going to be near home anytime soon. That would have while not ideal would have been the easiest way of treating this. Get the BS coming down, and then a script for what she needed.

Nothings wrong with you Tony. ■■■■ happens. Learn from it. We just need to be better prepared than non diabetes when we leave the house.
Here are a few ideas if you find yourself in that situation again:
1. I agree with what several others suggested. Call your Dr on an emergency basis. Explain the situation and get him (or whoever is covering for him/her to phone in a script to the CVS pharmacy for insulin and needles while you wait. This would have been your first and best option. Before I went on the pump, I took injections. I went on a trip and had my insulin, but forgot the needles. I was in a state where they require scripts for needles so my Dr phoned it in while I waited.
2. Another option, if you have some insulin on board, is to do aerobic exercise for 20 minutes or more until you check your BG and see it coming down towards the normal range. Keep going as long as it is working. Do jumping jacks, simulate jumping rope in place, run in place or jog a block back and forth, etc. Drink water when you are done since hydration seems to help bringing down BG levels. Do not do fast burst exercise like wind sprints, etc because this will have the opposite effect and raise your BG due to the adrenaline kicking in. Some people may not agree with exercising while your BGs are high, but under the circumstances I would do it.
3. Since you said you were at an event, it may have been worth going to the event coordinator / medical tent and ask them to help you find other diabetics. Perhaps they could have made an announcement asking if there were any diabetics there who could help out a fellow diabetic with medical supplies. This is a long shot, but considering you were in a jam it may have helped.

After hours, I think my endo's VM says "if this is an emergency, call 911..." and the whole emergency medical system is set up pretty much uselessly for diabetes..."were you eaten by a dog or shot? no? Ok, wait over there..." wheras it would really take a doc about 30 seconds to scribble an RX and get you out of there but they aren't inclined to provide that level of service.

But they should be. It would help us a lot and, frankly, it would also help them. When my pump blew up I was like "hmmm, spend 1-3 hours sitting around the ER to get an RX or continue planned weekend adventures and get some NPH to cover it..." which worked out ok. Not my best weekend ever but we still had a good time, priority #1!

all physician's after hours offices say that, "if emergency call 911." but most Endos also have a doc on call, which one can call at all hours, they're typically paged. i've had to do it on the weekend one time and endo called me back 5 minutes later and advised what to do with insulin, etc...

i can't imagine going to an ER and being turned away saying we don't have the right ER doesn't turn patients away, not in the US, and they have any/all drugs available to them at any time...!

Just FYI. Don't exercise with BG over 240. This can send you into DKA.

'When I finally talked to the doctor he said they didn't have any insulin only humulin!' Humulin is a type of insulin....this would have worked for you. Were you asking for a specific type of insulin that maybe they were saying they didn't have?

Some hospitals do only have NPH and Humulin R on hand in the ER. These are less expensive insulins, and are also older and I quite frankly think some doctors are just more comfortable with them than with the newer insulins. I've been hospitalized before and asked that I use my normal NovoLog. I had to have a new script written and submitted to the hospital pharmacy before the insulin would be brought to me and I was allowed to have 'my' kind of insulin. Even then they wouldn't give me Lantus, because the pharmacy in the hospital didn't stock it at all - I had to be given NPH. And this was at a major hospital associated with a medical college of an entire state...

I agree with others who said that the EMTs probably couldn't administer insulin to you. They don't carry a pharmacy on them, and probably didn't have any on hand. They likely have Glucagon...but not insulin. Even then, they'd wait until a doctor examined you because they don't know your dosage and wouldn't want to be accountable for killing you by too much insulin. I've been in severe DKA (unconscious, slipping in a coma), and even then was not given insulin until I was brought to the ER. The EMTs were only allowed to give me oxygen and start an IV line on the way to the hospital. They knew my blood sugar was sky high, because they tested....but couldn't do anything about it.